Fam Pract Manag. 1998 Jul-Aug;5(7):21.
A pound of prevention
To the Editor:
I was surprised and somewhat dismayed to read that “annual prostate cancer screening tests,” which “may include ... a prostate-specific antigen blood test,” will soon be covered by Medicare for men over age 50 (“An Ounce of Prevention,” April 1998). I hope this does not lead readers to believe that PSA is a recommended routine test. It is not. Neither the AAFP nor the American College of Physicians has recommended PSA testing as routine because 1) there are no studies to support the benefits of early detection outweighing the risks of complications from treatment, especially in males over 70 years old; 2) routine PSA testing without thorough discussion of the potential outcomes of testing is inappropriate; 3) PSA is an organ-specific test, not a disease-specific test, and as such is not a reliable screening test for prostate cancer; and 4) PSA is more effective when used to follow prostate cancer patients post-treatment to determine cure versus return/metastases.
The U.S. Preventive Services Task Force Report recommends against routine testing,1 for the reasons cited above.
I hope that by January 2000 we will have a safe, efficacious screening test for prostate cancer. If we don't, I feel it is ethically wrong (and potentially illegal) to order this test as a routine screening test, or even to refer to it as a “screening test.”
While an ounce of prevention is worth a pound of cure, a pound of prevention is not necessarily better.
1. Frame P, Berg A, Woolfe S. US preventive services task force: highlights of the 1996 report. Am Fam Phys. 1997; 55(2):567–576.
WE WANT TO HEAR FROM YOU
Send your comments to email@example.com. Submission of a letter will be construed as granting AAFP permission to publish the letter in any of its publications in any form. We cannot respond to all letters we receive. Those chosen for publication will be edited for length and style.
Copyright © 1998 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions